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El queratoquiste odontogénico constituye del 3 a 11% de los quistes odontogénicos. Se presenta desde la infancia hasta la vejez con mayor incidencia en hombres. La mandíbula está involucrada en el 60% al 80% de los casos, con una frecuencia en cuerpo y rama. Las lesiones de menor tamaño suelen ser asintomáticos, diagnosticados por examen radiográfico, no obstante, las lesiones más grandes pueden estar asociadas con dolor y aumento de volumen. Radiográficamente se observan lesiones uniloculares o multiloculares radiolúcidas de bordes nítidos, corticalizados, asociado a un diente retenido. Se presenta caso clínico de paciente género masculino de 30 años de edad, que exhibe una expresión atípica. Manifestándose como una doble lesión de queratoquistes odontogénicos independientes entre sí, localizados en rama y cuerpo mandibular derecha, tratado en el Servicio de Cirugía Maxilofacial del Hospital San José, Santiago de Chile. Se describe diagnóstico y tratamiento quirúrgico realizado. El interés clínico del caso es la presencia de dos lesiones independientes entre sí, con el mismo diagnóstico. Presentación que nos parece fundamental reportar en la literatura científica debido a su alto alcance e impacto.
The odontogenic keratocyst represents 3 to 11% of all odontogenic cysts. It occurs from childhood to old age with a higher incidence in men. The mandible is involved in 60% to 80% of cases, with a frequency in the body and ramus. Smaller lesions are usually asymptomatic and diagnosed by radiographic examination. However, larger lesions may be associated with pain and increased volume. Radiographically, radiolucent unilocular or multilocular lesions with sharp, corticalized edges are observed, associated with an impacted tooth. A clinical case of a 30-year-old male patient, who exhibits an atypical expression, is presented. A double lesion of odontogenic keratocysts independent of each other appears, located in the right mandibular ramus and body, treated in the Maxillofacial Surgery Service of the San José Hospital, Santiago de Chile. Diagnosis and surgical treatment performed are described. The clinical interest of the case is the presence of two lesions independent of each other, with the same diagnosis. It seems fundamental to us to report it in the scientific literature due to its high scope and impact.
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Objetivo: Presentar un caso clínico de un tumor odon- togénico epitelial calcificante (TOEC), así como una revisión de la literatura disponible sobre esta neoplasia para contribuir al análisis del mejor método de tratamiento de la patología. Caso clínico: Se presenta el caso de una paciente mujer de 35 años con un tumor odontogénico epitelial calcifican- te que recibió tratamiento de enucleación quirúrgica con una evolución favorable y seguimiento de 5 años por medio de evaluación clínica y radiológica. La elección terapéutica se basó en el resultado de un análisis exhaustivo de la literatura para determinar el mejor abordaje de la neoplasia (AU)
Aim: To present a clinical case of a calcifying epithelial odontogenic tumor (CEOT), as well as a review of the availa- ble literature on this neoplasia to contribute to the analysis of the best treatment method for the pathology. Clinical case: The case of a 35-year-old patient with a calcifying epithelial odontogenic tumor who received surgical enucleation treatment with a favorable evolution and 5-year follow-up through clinical and radiological evaluation is pre- sented. The therapeutic choice was based on the result of an exhaustive analysis of the literature to determine the best ap- proach to the neoplasia (AU))
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Humanos , Femenino , Adulto , Neoplasias Mandibulares/cirugía , Tumores Odontogénicos/clasificación , Procedimientos Quirúrgicos Orales/métodos , Biopsia/métodos , Tumores Odontogénicos/diagnóstico por imagen , Estudios de SeguimientoRESUMEN
Los quistes de los maxilares son las lesiones óseas más comunes en la región maxilofacial. La enucleación de las lesiones y el cierre primario de los defectos, son en conjunto, el tratamiento óptimo hoy en día. En algunas ocasiones el defecto óseo resultante puede ser de un tamaño tan grande que afecta la estabilidad de dientes vecinos, comprometa la indemnidad del hueso o produce un retraso cicatrizal que incluso puede impedir una regeneración ósea completa. Se considera que esta falta de regeneración expone al paciente a riesgos de infección tardía, retraso de los tratamientos rehabilitadores en zonas de alta demanda estética y pérdida de vitalidad dentaria. Para disminuir el riesgo de alteraciones en la regeneración ósea completa de cavidades quísticas, se ha propuesto la posibilidad de que tras la enucleación del quiste se rellenen estos defectos con injertos óseos u otras técnicas de preservación alveolar para favorecer la cicatrización. Teóricamente el uso de estos injertos mejora la calidad y disminuye el tiempo de cicatrización ósea, permitiendo que el paciente recupere rápidamente las funciones habituales del componente dentoalveolar, acortando el periodo de cuidados postoperatorios que restringen la alimentación, los deportes o la rehabilitación oral. El actual trabajo tiene como objetivo realizar una revisión de la literatura respecto a los beneficios del uso de injertos óseos en el tratamiento quirúrgico de los quistes maxilares y presentar un caso clínico con los detalles quirúrgicos de esta técnica.
Jaw cysts are the most common bone lesions in the maxillofacial region. Enucleation of the lesions along with the primary closure of the defects are the optimal treatment nowadays. On some occasions, the resulting bone defect can be so large that it affects the stability of neighboring teeth, compromises the integrity of the bone, or produces a delayed healing that can even prevent complete bone regeneration. It is considered that the lack of regeneration exposes the patient to risk of infection, delay of rehabilitation treatments in areas of high aesthetic demand and loss of dental vitality. To reduce the risk of alterations in complete bone regeneration of cystic cavities, the possibility of filling these defects with bone grafts or other alveolar preservation techniques to promote healing, has been proposed after cyst enucleation. Theoretically, the use of these grafts improves the quality and decreases the bone healing time, allowing the patient to quickly recover the usual functions of the dentoalveolar component, limiting the period of postoperative care that restricts eating, sports or oral rehabilitation. The present work aims to carry out a review of the literature regarding the benefits of the use of bone grafts in the surgical treatment of maxillary cysts and to present a clinical case with the surgical details of this technique.
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Objective:To investigate the efficacy and safety of en-bloc Holmium laser enucleation of the prostate (HoLEP) with an early apical mucosa dissection technique for the treatment of benign prostate hyperplasia (BPH).Methods:The clinical data of 215 patients treated with HoLEP for BPH from January 2020 to January 2023 in the Department of Urology, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. According to different treatment methods, the patients were divided into study group ( n=112) and control group ( n=103). Patients in the study group were treated by the en-bloc HoLEP with an early apical mucosa dissection technique, while patients in the control group were treated by the classical two or three-lobes HoLEP. The primary endpoints included the rates of urinary incontinence at 1-month, 3-month, and 6-month after surgery in two groups of patients. The secondary endpoints included operative time, hemoglobin decrease, dissected prostate weight, postoperative indwelling catheter time, postoperative hospital stay, and international prostate symptom score (IPSS), quality of life (QoL), Qmax, and postvoid residual urine (PVR) at 3-month and 6-month after surgery. The measurement data were tested by Shapiro-Wilk normality test. The normal distribution of the measurement data were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for comparison between two groups. Measurement data of skewness distribution were expressed as median (interquartile distance) [ M( Q1, Q3)], and Wilcoxon or Mann-Whitney U test were used for comparison between two groups. The count data in the two groups were compared by the Chi-square test. Results:The incidence of urinary incontinence in the study group was 9.0% (10/112) and 3.6% (4/112) at 1-month and 3-month after surgery, which was significantly lower than those in the control group [18.5% (19/103) and 11.7% (12/103)], and the differences were statistically significant ( P< 0.05). Urinary incontinence in two groups recovered completely 6-month after surgery. The operation time of the study group was (68.74±23.71) min, which was lower than that of the control group [(88.04±25.43) min], and the difference was statistically significant ( P<0.05). There were no significant differences in hemoglobin decrease, dissected prostate weight, postoperative indwelling catheter time, postoperative hospital stay in the two groups ( P> 0.05). The IPSS, QoL, Qmax and PVR of the two groups were significantly improved at 3-month and 6-month after surgery ( P< 0.05), but there was no significant difference between the two groups ( P> 0.05). Conclusion:En-bloc HoLEP with an early apical mucosa dissection technique is safe and reliable in treating BPH, and has advantages over classic HoLEP in terms of short-term urinary continence rates, shortening operation time.
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Objective:To compare the clinical safety and the efficacy of the transurethral plasmakinetic bipolar enucleation of the prostate and diode laser enucleation of the prostate in day surgery patients.Methods:The clinical data of 99 patients with benign prostatic hyperplasia (BPH) who underwent day surgery in Zhujiang Hospital of Southern Medical University from August 2019 to August 2021 were retrospectively analyzed. Among them, 47 cases underwent transurethral plasmakinetic bipolar enucleation of the prostate (bipolar group), and 52 cases were treated with diode laser enucleation of the prostate (diode laser group). There were no significant differences in age [57.0(56.0, 61.0)years old vs. 59.0(57.0, 62.0)years old], prostate volume[(60.0±8.2)ml vs. (57.4±9.4)ml], preoperative total prostate-specific antigen (tPSA) [(1.8±0.9) ng/ml and (2.2±0.9) ng/ml], postvoid residual (PVR) [20.0(0, 40.0)ml vs. 20.0(1.3, 41.5)ml], maximum flow rate (Q max) [(9.4±2.6) ml/s vs. (9.6±1.9) ml/s], International Prostate Symptom Score (IPSS) [19.0(16.0, 21.0) vs. 19.0(18.0, 21.0)], quality of life (QOL) [5.0(4.0, 5.0)vs. 5.0(4.0, 5.0)] and International Index of Erectile Function 5 (IIEF-5) [(18.8±1.0) vs. (19.2±0.9)] score between the bipolar group and diode laser group (all P>0.05). The indexes of operation time, postoperative hemoglobin decline, blood sodium decline, bladder irrigation time, catheter indwelling time, Q max, IPSS, QOL, IIEF-5 score and so on were compared between the two groups. Results:All day surgeries were successfully completed without serious complications. The operation time of the bipolar group was less than that of the diode laser group [(57.3 ± 4.2) vs. (64.4 ± 6.3) min, P<0.001], and no statistically significant difference was found in the postoperative hemoglobin decline between the two groups [(9.8 ± 4.3) g/L vs. (8.5 ± 4.3) g/L, P=0.154]. None of the patients received transfusion treatment, and neither group of patients had severe hematuria or needed to be readmitted to hospital. There was no significant difference in the decrease of blood sodium [1.7 (1.3, 2.0) mmol/L vs. 1.7 (1.5, 1.9) mmol/L] and the postoperative bladder irrigation time [(7.7 ± 1.4)h vs. (8.0 ± 1.6)h] between the bipolar and diode laser groups ( P > 0.05). There were 8 patients in the bipolar group and 7 patients in the diode laser group who retained urinary catheter for 48-60 h due to intraoperative inflammatory changes in the prostate, and the remaining patients had their urinary catheter removed within 24 hours. The Q max of the bipolar group and the diode laser group one month after surgery were (20.4 ± 1.8) and (21.1 ± 1.7) ml/s, IPSS scores were 7.0 (7.0, 8.0) and 7.0 (7.0, 8.0), and QOL scores were 3.0 (3.0, 3.0) and 3.0 (2.0, 3.0), respectively. There were no significant differences in Q max, IPSS and QOL between the two groups (all P > 0.05). Conclusions:Transurethral plasmakinetic bipolar enucleation of the prostate is also feasible for day surgery, and the short-term postoperative Q max, IPSS, hemoglobin reduction and other indicators have no significant difference compared with diode laser enucleation of the prostate, and can achieve the same efficacy and safety as diode laser enucleation of prostate.
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ABSTRACT Sympathetic ophthalmia is a rare and potentially devastating bilateral diffuse granulomatous panuveitis. It is caused by surgical or non-surgical eye injuries and is an uncommon and serious complication of trauma. It is diagnosed clinically and supported by imaging examinations such as ocular ultrasonography and optical coherence tomography. Its treatment consists of immunosuppressive therapy with steroids and sometimes steroid-sparing drugs, such as cyclosporine, azathioprine, cyclophosphamide, and mycophenolate mofetil. Fast and effective management with systemic immunosuppressive agents allows for disease control and achievement of good visual acuity in the sympathizing eye. By contrast, enucleation should be considered only in situations where the injured eye has no light perception or in the presence of severe trauma. In addition to a bibliographic review of this topic, we report six cases involving different immunosuppressive and surgical treatment modalities.
RESUMO A oftalmia simpática consiste em uma panuveíte granulomatosa bilateral rara e potencialmente devastadora, ocorrendo geralmente após trauma ocular cirúrgico ou não cirúrgico. O diagnóstico é baseado em aspectos clínicos e apoiado por exames de imagem, como ultrassonografia ocular e tomografia de coerência óptica. O tratamento consiste em terapia imunossupressora com esteróides e, eventualmente, drogas poupadoras de esteróides, como ciclosporina, azatioprina, ciclofosfamida e micofonato de mofetila. O manejo rápido e eficaz com agentes imunossupressores sistêmicos permite o controle da doença e a obtenção de boa acuidade visual no olho simpatizante. A enucleação, por outro lado, poderia ser considerada apenas em situações em que o olho lesado não tem percepção luminosa ou há trauma grave. Além de uma revisão bibliográfica sobre o tema, foi relatada uma série de 6 casos com diferentes modalidades de tratamento imunossupressor e cirúrgico.
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El fibroma ameloblástico (FA) es una neoplasia benigna con potencial de recurrencia y transformación maligna que afecta los huesos maxilofaciales. Se analizaron casos recientes de FA para describir sus características clínicas y opciones de tratamiento. El objetivo de este estudio es mejorar la comprensión de esta enfermedad poco común y brindar información relevante para el diagnóstico y manejo de los pacientes. Se realizó una revisión de la literatura en busca de reportes de caso de FA publicados en los últimos 5 años. Después de eliminar duplicados, se seleccionaron 16 estudios para su análisis. Se recopilaron datos sociodemográficos, ubicación de la lesión, signos clínicos, hallazgos radiográficos y opciones de tratamiento. Los estudios incluidos en el análisis reportaron casos de FA en pacientes con edades entre 4 y 21 años. Se observó una ligera predominancia en hombres. La ubicación más común de la lesión fue la mandíbula posterior. Los signos clínicos más frecuentes fueron el aumento de volumen óseo y el dolor. Radiográficamente, se encontraron principalmente lesiones radiolúcidas multiloculares. El tratamiento más común fue la enucleación de la lesión. No se observaron recurrencias durante el seguimiento de los casos reportados. Los resultados coinciden con la literatura reciente, proporcionando información actualizada sobre el perfil clínico y radiográfico del FA. La enucleación se muestra como una opción efectiva de tratamiento. Estos hallazgos contribuyen al diagnóstico preciso y al manejo adecuado de los pacientes con FA, resaltando la importancia de comprender las características clínicas de esta neoplasia.
Ameloblastic fibroma (AF) is a benign neoplasm with the potential for recurrence and malignant transformation that affects the maxillofacial bones. Recent cases of AF were analyzed to describe their clinical characteristics and treatment options. The objective of this study is to enhance understanding of this rare disease and provide relevant information for the diagnosis and management of patients. A literature review was conducted to identify case reports of AF published in the past 5 years. After removing duplicates, 16 studies were selected for analysis. Sociodemographic data, lesion location, clinical signs, radiographic findings, and treatment options were collected. The included studies reported cases of AF in patients aged between 4 and 21 years. There was a slight male predominance. The most common location of the lesion was the posterior mandible. The most frequent clinical signs were increased bone volume and pain. Radiographically, predominantly multilocular radiolucent lesions were found. The most common treatment was lesion enucleation. No recurrences were observed during the follow-up of the reported cases. The results align with recent literature, providing updated information on the clinical and radiographic profile of AF. Enucleation emerges as an effective treatment option. These findings contribute to accurate diagnosis and appropriate management of patients with AF, highlighting the importance of understanding the clinical characteristics of this neoplasm.
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Ameloblastoma is a benign, locally aggressive neoplasm that constitutes about 1–3% of the tumors of the jaw. Wide surgical excision with adequate safe margin is the most common treatment of choice. The study aimed to manage cases with unicystic ameloblastoma while preserving the continuity of the mandible (without resection). This article presents a series of cases ranging from 18 to 40 years old patients of both sexes with unicystic ameloblastoma, especially in the mandible showing more male predilection than female. All the cases presented in this article were treated by enucleation and curettage. None of the patients presented post?operative paresthesia. None of the cases went in for resection. Post?operative recovery was uneventful in all the patients. All the patients were followed up for a period of 3.5–5 years. None of the cases reported recurrence at the date of publication.
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The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.
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Masculino , Humanos , Estudios Retrospectivos , Hiperplasia Prostática/cirugía , Estudios de Seguimiento , Holmio , Calidad de Vida , China , Resultado del Tratamiento , Síntomas del Sistema Urinario Inferior/cirugía , Terapia por Láser , Láseres de Estado Sólido/uso terapéuticoRESUMEN
【Objective】 To compare the efficacy and safety of thulium laser enucleation of the prostate (ThULEP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in PubMed, Embase, Cochrane Library, CNKI and Wanfang Database from Jan.1,2010 to May 30,2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. All divergences were resolved by a third researcher. RevMan 5.4 software was used for Meta analysis. 【Results】 A total of 7 studies were included, involving 1 726 patients, 750 in the ThULEP group and 976 in the HoLEP group. Meta analysis showed that, compared with HoLEP group, the ThULEP group had shorter catheter indwelling time [MD=-0.10, 95%CI (-0.17--0.03), P=0.004] , shorter hospital stay [MD=-0.43, 95%CI (-0.60--0.25), P<0.000 01] , lower IPSS score 12 months after surgery [MD=-1.13, 95%CI (-1.95- -0.30), P=0.007] , lower QoL score 12 months after surgery [MD=-1.00, 95%CI (-1.19- -0.81), P<0.001] ,lower transfusion rate [OR=0.11, 95%CI (0.03-0.36), P=0.000 3] and lower incidence of urinary incontinence [OR=0.24, 95%CI (0.09-0.66), P=0.006] . 【Conclusion】 ThULEP may have similar efficacy and safety as HoLEP in the treatment of BPH, and has more advantages in some aspects.
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【Objective】 To introduce the learning experience of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) in county-level hospitals. 【Methods】 The clinical data of 500 cases of BPH treated with HoLEP during May 2018 and Dec.2022 were retrospectively analyzed. The learning curve was divided into three stages: learning, maturity and proficiency stages. In each stage, the operation time, postoperative bladder irrigation time and rate of urinary incontinence of 20 patients were analyzed. 【Results】 All operations were performed by the same surgeon. During the learning stage, the operation time and bladder irrigation time were significantly longer, and the rate of urinary incontinence was significantly higher. At the proficiency stage, the operation time, bladder irrigation time, and rate of urinary incontinence were significantly improved. 【Conclusion】 HoLEP technique needs to be developed step by step with a certain learning curve. Continuous learning and mastery of key technical points are necessary for surgeons in county-level hospitals to avoid postoperative urinary incontinence.
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【Objective】 To compare the efficacy and safety of blue laser en bloc enucleation and traditional plasmakinetic electrocautery in the treatment of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A total of 50 NMIBC patients treated in our hospital during Oct.2018 and Dec.2019 were enrolled. A randomized, incomplete blinding, parallel control design and non-inferior test method was adopted. The control group (electrocautery group) used plasmakinetic electrocautery for transurethral resection, and the experimental group (blue laser group) used semiconductor blue laser for transurethral en bloc enucleation. The effective resection rate, operation time, postoperative catheter indwelling time, length of hospital stay, perioperative hemoglobin changes and obturator nerve reflex were compared. 【Results】 There were 24 patients in the blue laser group and 26 in the electrocautery group. The effective dissection rate and hemostasis rate in both groups reached 100%. The blue laser group had slightly longer operation time than the electrocautery group (55 min vs.42 min, P=0.009), but lesser hemoglobin decrease (5.7 g/L vs. 10.4 g/L, P=0.007). There were no significant differences in urinary catheter indwelling time, length of hospital stay and reoperation rate between the two groups. The electrocautery group had 3 cases of obturator nerve reflex, while the blue laser group had none. 【Conclusion】 Compared with the traditional electrocautery, blue laser has good vaporization cutting and coagulation hemostatic effects on bladder tumor tissue, and can completely enucleate tumors in a front-firing model with less bleeding and no obturator nerve reflex, which can be used as a new, efficient, safe and easy-to-learn method for NMIBC surgery. However, its effects on postoperative recurrence rate and progression rate still need further studies.
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【Objective】 To observe the efficacy of blue laser side light in the vaporization and enucleation of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A retrospective analysis was performed on the data of NMIBC patients who received transurethral enucleation of bladder tumor (TURBT) using a 50 W blue laser treatment device. The efficacy and safety of surgery were evaluated by observing the application of blue laser in the treatment of bladder cancer in different locations, operation time, presence of bladder perforation and postoperative urine routine indicators. 【Results】 A total of 16 patients completed the surgery, including 5 cases with multiple bladder tumors, 9 with single bladder tumor, and 2 with lichenoid lesions. The postoperative pathological results showed all of them were NMIBC. The operation time was (10.4±4.7) min, postoperative urinalysis was (689.4±316.7)/μL, and no intraoperative bladder perforation occurred. 【Conclusion】 The lateral infusion mode of 50 W blue laser therapy device can be applied to the surgical treatment of NMIBC. The basal vaporization and enucleation of bladder cancer can be performed under direct vision conditions, and the multi-angle enucleation is suitable for bladder cancer in different positions. The tissue penetration depth of blue laser is shallow, which is conducive to the diagnosis and grading of pathological tissues.
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【Objective】 To establish a model for predicting the risk of urinary incontinence after holmium laser enucleation of the prostate (HoLEP). 【Methods】 The clinical data of 258 patients with benign prostatic hyperplasia (BPH) who underwent HoLEP in our hospital during Jan.2019 and Feb.2022 were retrospectively analyzed. According to the occurrence of urinary incontinence after surgery, they were divided into the urinary incontinence group (n=84) and non-urinary incontinence group (n=174). Lasso regression was used to screen the predictors of urinary incontinence after HoLEP. Logistic regression was used to establish a suitable model, and a nomogram of urinary incontinence after HoLEP was drawn. Bootstrap was used to verify and draw the calibration curve of the model, calculate the C index, and draw the clinical decision curve to further verify the accuracy and identification ability of the model. 【Results】 Predictors including International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), body mass index (BMI), diabetes, prostate volume (PV), and prostate-specific antigen (PSA) were selected, based on which a prediction model was constructed. The area under the receiver operating characteristic (ROC) curve of the prediction model was 0.766 0, and the 95% confidence interval was 0.704-0.828. Bootstrap internal validation showed a C-index of 0.766 2, and the calibration model curve coincided well with the actual model curve. The clinical decision curve analysis showed that the model had high accuracy, and net benefit in the probability of urinary incontinence was within 10% to 82%. 【Conclusion】 IPSS, QoL, diabetes, prostate volume, and PSA are predictors that can affect the occurrence of urinary incontinence after HoLEP. The model has high accuracy, identification ability and net benefit.
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Objective:To investigate the efficacy and safety of en-bloc low-power (22.5 W) holmium laser for enucleation of prostate (LP-HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods:The clinical data of 98 patients with BPH who underwent surgical treatment in the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2020 to October 2022 were retrospectively analyzed. They were divided into LP-HoLEP group ( n=53) and TURP group ( n=45) according to different treatment methods. Patients in the LP-HoLEP group were treated with en-bloc holmium laser enucleation of prostate, and patients in the TURP group were treated with transurethral resection of prostate (TURP). Perioperative indexes of the two groups were compared, including operation time, postoperative hemoglobin changes, tissue resection amount, postoperative catheter indentation time, postoperative hospital stay, complications, and international prostate symptom score (IPSS), quality of life (Qol) score, maximum urine flow rate (Qmax), postvoid residual volume (PVR) and other indicators were obtained at 3 and 6 months after surgery. The measurement data were tested by Shapiro-Wilk normality test. The measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), independent sample t-test was used for comparison between groups, measurement data of skewness distribution were expressed as median (interquartile distance)[ M( Q1, Q3)], and Mann-Whitney U test was used for comparison between groups. The Chi-square test was used to compare the count data between groups. Results:In the LP-HoLEP group, the operative time was (65.74±22.82) min, the hemoglobin decreased 5.71(3.97, 9.01) g/L, the tissue resection volume was (60.59±24.40) g, and the catheter indinduration time was (3.03±0.91) d. The length of postoperative hospitalization was (4.14±1.05) d. TURP group was (77.04±27.33) min, 11.02(8.89, 16.51) g/L, (39.49±11.32) g, (4.80±0.91) d, (5.98±1.03) d, respectively. All the indexes of LP-HoLEP group were better than TURP group. The differences were statistically significant ( P<0.05). Compared with preoperative, IPSS, Qol score, Qmax and PVR of two groups were significantly improved at 3 months after surgery, but there were no statistical significance between groups ( P>0.05). Conclusion:En-bloc LP-HoLEP is safe and reliable in the treatment of BPH, and has advantages over TURP in terms of tissue resection volume, shortening hospitalization and indwelling catheter time, and reducing intraoperative bleeding.
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A total of 360 patients with prostate hyperplasia underwent transurethral holmium laser enucleation of the prostate in Department of Urology of Jinhua People′s Hospital from July 2019 to December 2022. Among 360 patients, lower urinary tract symptoms occurred one month after operation in 40 cases with an incidence rate of 11.11%. The age, body mass index (BMI), course of disease, nature of disease, preoperative prostate volume, postoperative prostate volume, preoperative IPSS score, postoperative IPSS score, preoperative maximum urine flow rate, postoperative maximum urine flow rate, preoperative residual urine volume, postoperative residual urine volume, postoperative urinary tract infection, operative time, postoperative catheter retention time were compared between patients with lower urinary tract symptoms (study group) and those without (control group). There were significant differences in the course of disease, preoperative prostate volume, preoperative IPSS score, preoperative maximum urine flow rate, preoperative residual urine volume, postoperative urinary tract infection and postoperative catheter retention time between two groups ( t=28.01, 6.35, 8.79, 17.92, 34.84, 11.45;all P<0.05). Multivariate logistic analysis showed that the course of disease, preoperative prostate volume, preoperative IPSS score, postoperative urinary tract infection, and postoperative catheter retention time were independent risk factors for postoperative lower urinary tract symptoms ( OR=6.964, 3.442, 1.944, 4.836, 4.225, 4.894; all P<0.05); while the preoperative maximum urinary flow rate was the protective factor( OR=0.043, P<0.05). The incidence of postoperative lower urinary tract symptoms in patients undergoing transurethral holmium laser enucleation of prostate is high. Effective protective measures should be taken based on the risk factors to reduce the incidence of postoperative lower urinary tract symptoms and to promote the early recovery of patients.
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Objective:To evaluate the safety and efficacy of bipolar plasmakinetic endoscopic enucleation of the prostate (BEEP) in the treatment of benign prostatic hyperplasia (BPH) in a day surgery mode.Methods:The clinical data of 162 BPH patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2021 to June 2022 were analyzed retrospectively. The patients were divided into day group(80 cases) and conventional group(82 cases) according to hospitalization mode. In the day group, preoperative screening and anesthesia evaluation was completed during the pre-hospitalization period, and the patient was discharged within 24 hours. The two groups were treated with BEEP, the urethral mucosa was cut at a " Ω" 5 mm proximal to the external sphincter ring in front of the verumontanum. Following the standard of anatomical enucleation of the prostate, the gland tissue was cut out after enucleation. There were no significant differences in age [(63.6±8.9) years vs. (67.5±7.1) years], body mass index [(24.3 ±2.6) kg/m 2vs. (23.0±3.2) kg/m 2], prostate volume [(55.8±16.9) ml vs. (53.7±20.7) ml], preoperative prostate-specific antigen [3.8(1.2, 5.3)ng/ml vs. 3.5(2.1, 5.6)ng/ml], the international prostate symptom score (IPSS) [(25.9±5.2) vs. (26.3±5.9)], the quality of life score (QOL) [(5.0±0.7) vs.(5.0±0.6)], the maximum urine flow rate (Q max) [(8.2±4.5) ml/s vs. (7.9±4.1) ml/s] and residual urine volume (PVR) [49(0, 131) ml vs. 45(11, 106) ml] between the two groups ( P>0.05). The waiting time before admission was [(2.6±1.2) d vs. (5.3±1.5) d], and the difference between the two groups was statistically significant ( P<0.05). The perioperative efficacy indicators, total hospitalization expenses and short-term postoperative complications were compared between the two groups. Results:In this study, all patients successfully completed the operation. There were no statistical significances in the perioperative indicators between the day group and the conventional group including the operation time [(38.4±15.2) min vs. (40.4±13.9) min], enucleated tissue weight [(34.6±9.6) g vs. (35.4±10.8) g], the decrease value of hemoglobin [(13.0±2.5) g/L vs. (12.0±3.7) g/L] and the decrease value of blood sodium [(2.2±0.9) mmol/L vs. (2.4±1.3) mmol/L]( P>0.05). The significant differences were observed in bladder irrigation time [(16.9±2.1)h vs. (22.7±12.1)h], catheterization time [(18.8±5.1) h vs.(65.6±13.0)h], postoperative hospital stay [(16.8±2.4)h vs. (64.8±6.3)h] and the total hospitalization expenses [(13 282.2±2 236.3) yuan vs. (15 969.3±2 420.6) yuan] between the day group and the conventional group ( P < 0.01). In the day group, 1 case was transferred to the general ward for observation for 1 day. There were no significant differences in the incidence of complications as urinary retention [6.3% (5/80) vs. 3.7% (3/82)], temporary incontinence [2.5% (2/80) vs. 2.4%(2/82)], urethra stricture [7.5% (6/80) vs. 6.1% (5/82)], and hematuria for intervention [1.3% (1/80) vs. 1.2% (1/82)]between the day group and the conventional group ( P > 0.05). After 6 months of follow-up, there were no significant differences in IPSS[(6.7±2.8) vs. (6.1±2.5)], QOL[(1.8±0.9) vs. (2.0±0.8)], Q max [(26.4±5.5)ml/s vs. (25.8±4.6)ml/s] and PVR [7(2, 11)ml vs. 5(4, 8)ml] between the two groups at 6 months after operation ( P > 0.05), but there were significant improvements when compared with those items of preoperation ( P < 0.01). Conclusions:The treatment of BPH with BEEP in the day surgery mode is as safe and effective as that in the conventional surgery mode, with little bleeding, high resection efficiency, definite therapeutic effect and low incidence of complications. BEEP can shorten the length of hospital stay and reduce medical expenses in the day surgery mode, and can be carried out in hospitals with conditions.
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To evaluate the safety and clinical effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) with biliary and pancreatic duct stenting combined with enucleation (En) for cystadenoma in pancreatic head, clinical data of patients with cystadenoma in pancreatic head treated by ERCP+En (ERCP+En group, n=11) or En (En group, n=12) at Hangzhou First People's Hospital from January 2020 to January 2023 were retrospectively analyzed. The general information, intraoperative condition, perioperative complications, hospital stay, and follow-up outcomes were compared between the two groups. No noteworthy difference in general information was observed between the two groups ( P>0.05). In the ERCP+En group, ERCP was successfully implanted into the biliary pancreatic duct stent, and hyperamylasemia occurred in 3 cases after ERCP, which improved after conservative treatment. No conversion to laparotomy or blood transfusion occurred during the En operation, and no serious complication occurred after EN operation in the two groups. There was 0 case and 3 cases of grade B/C postoperative pancreatic fistula in the ERCP+En group and the En group, respectively ( P=0.001). The median hospital stay was 11 days and 15 days, respectively, with statistical significance ( U=2.25, P=0.031). No noteworthy difference in median En time (145 min VS 155 min, U=0.03, P=0.952) or intraoperative blood loss (100 mL VS 120 mL, U=0.05, P=0.784) was observed between the two groups. During a median follow-up of 18 months, no recurrence happened in either group, and the ERCP+En group did not experience biliary pancreatic duct stenosis, while the En group experienced 2 pancreatic duct stenosis and 1 biliary duct stenosis. Endoscopic biliary and pancreatic duct stenting combined with En is an effective way to reduce postoperative pancreatic fistula and avoid long-term complications such as biliary and pancreatic duct stenosis for cystadenoma in pancreatic head.
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Objective@#This study determined the treatment outcomes of patients with retinoblastoma seen at a Philippine tertiary government hospital from January 2000 to January 2020.@*Method@#This is a cohort study. Medical records of patients with histopathologic-proven retinoblastoma were reviewed and pertinent information on clinical profile and presentation, treatment and outcomes were recorded.@*Results@#This study included 118 patients (146 eyes) with mean age at symptom onset of 7.4 + 6.6 months and mean age at consult of 11.5 + 13.7 months. There were 69 (47%) eyes with International Classification of Retinoblastoma (ICRB) stage E. The most common primary treatment was enucleation (n=137, 94%). The most common high-risk histopathologic feature was involvement of the optic nerve at the cut-end section (n=27, 34%). Only 14 patients (11%) completed treatment with median follow-up of 30.5 months (range 4- 122). @*Conclusion@#The rate of overall survival of patients with retinoblastoma is low in this study, similar to other developing countries. This can be due to higher proportion of patients with advanced stage at presentation and lower percentage of treatment completion. Early diagnosis and treatment may lead to better survival rate, visual outcome and quality of life. Due to limited data on follow-up, globe preservation could not be determined.
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Retinoblastoma , Tasa de SupervivenciaRESUMEN
Benign prostatic hyperplasia (BPH) surgery has developed for more than 100 years. After several major revolutions, it is still constantly innovating, which in turn has profoundly affected people’s concept and strategy for treating BPH. This paper reviews the background and process of the evolution of BPH surgery, discusses the innovative methods and rules, and looks forward to the future developmental trend, in order to provide reference for the further development of BPH surgery.